Clasificacion OTA Completa

J Orthop Trauma Volume 21, Number 10 Supplement, November/December 2007 S1

Summary: The purpose of this new classification compendium is torepublish the Orthopaedic Trauma Associations (OTA) classification.The OTA classification was originally published in a compendium ofthe Journal of Orthopaedic Trauma in 1996. It adopted TheComprehensive Classification of the Long Bones developed by Mllerand colleagues and classified the remaining bones. In this com-pendium, the introductory chapter reviews new scientific informationabout classifying fractures that has been published in the last 11 years.The classification is presented in a revised format that is easier to fol-low. The OTA and AO classification will now have a unified alpha-numeric code eliminating the differences that have existed betweenthe 2 codes. The code was significantly revised for the clavicle andscapula, foot and hand, and patella. Dislocations have been expandedon an anatomic basis and for most joints will be coded separately. Thispublication should stimulate new developments and interest in a uni-fied language to code and classify fractures. Further improvements inclassification will result in better patient care and clinical research.

J Orthop Trauma 2007;21(Suppl.): S1-S133

THE RATIONALE FOR REPUBLISHING The Orthopaedic Trauma Association (OTA) fracture

classification was published in a compendium of the Journal ofOrthopaedic Trauma (JOT) in 1996.1 It adopted TheComprehensive Classification of Fractures of the Long Bones developed by Mller and collaborators,2 classified bonesthat had not been previously classified and revised the alpha-

numeric code developed by the Mller group. In their introduc-tion to the 1996 compendium, the Coding and ClassificationCommittee noted that the goal of the comprehensive classifica-tion was to classify fractures in a uniform and consistent fash-ion to allow standardization of research and communication.1

The committee observed that the current state of fracture clas-sification was ineffective for these purposes with multiple di-verse systems used in different parts of the skeleton for variouspurposes, thwarting any possibility of a standardized languageand accumulation of uniform data. Their intent was for the newclassification to be a flexible, evolving classification system inwhich changes would be made based on comment, criticismand appropriate clinical research. In this way the classificationcould continue to optimally serve the needs of orthopedic trau-matologists for both clinical practice and research.

Since the compendium was published in 1996, the classi-fication has resided on the OTA website and has been regularlyused in trauma databases in North American Trauma Centers. Itis the official classification of the OTA and of the JOT. In theseways it has developed wide acceptance and has dramatically im-proved the way information about fractures is communicated,stored, and used to advance knowledge through clinical re-search. In some anatomic areas this classification has largelysupplanted all others, achieving one of the original intents.

Unfortunately, the OTA classification has not achievedsome of its originally stated goals. It has not been modifiedsince 1996 and therefore it has not been the flexible, evolv-ing classification envisioned when it was published. It alsohas not become a truly universal language of communicationbecause multiple other anatomically specific classificationsstill exist and are part of commonly used fracture language,and for some areas of the skeleton they are still preferred.

Since 1996, considerable new scientific information hasbeen published about fracture classification in general and theOTA system in particular. Factors leading to poor reliabilityand reproducibility of fracture classifications have been inten-sively studied. These studies have led to important new infor-mation on how clinicians interpret images of fractures onradiographs and the process by which fractures are classified.Unfortunately, difficulties with classification reliability haveled to some loss of enthusiasm with the classification process.It is now widely recognized that, to ensure that any classifica-tion is suitably reliable, it must undergo an intense and rigor-ous scientific scrutiny. The effort required is considerable,and this difficult process has either been ignored or avoidedin favor of popular and widely used classifications.

Fracture and Dislocation Classification Compendium - 2007

Orthopaedic Trauma Association Classification, Database and Outcomes Committee

J.L. Marsh, MD,* Theddy F. Slongo, MD, Julie Agel, NA, ATC, J. Scott Broderick, MD, William Creevey, MD,! Thomas A. DeCoster, MD, Laura Prokuski, MD,# Michael S. Sirkin, MD,**

Bruce Ziran, MD, Brad Henley, MD, Laurent Audig, DVM, PhD

From the *Department of Orthopaedics and Rehabilitation, The University of IowaHospitals and Clinics, Iowa City, IA; Department of Paediatric Surgery,Paediatric Trauma and Orthopaedics, University Children's Hospital, BernSwitzerland; Department of Orthopaedics, Harborview Medical Center, Seattle,WA; Greenville University Medical Center, Greenville, SC; !Department ofOrthopaedic Surgery, Boston University Medical Center, Boston, MA;Department of Orthopaedics and Rehabilitation, University of New Mexico,Albuquerque, NM; #University of Wisconsin, Madison, WI; **Department ofOrthopaedics, New Jersey Medical School, Newark, NJ; Orthopaedic Trauma,St. Elizabeth Health Center, Orthopaedic Surgery Northeast Ohio UniversitiesCollege of Medicine, Youngstown, OH; AO Clinical Investigation andDocumentation, Dbendorf, Switzerland

Disclosure: Dr. Henley is a consultant for Zimmer. The remaining authors reportno conflicts of interest.

Material presented in this Compendium is based on the ComprehensiveClassification of Fractures of Long Bones, by M.E. Mller, J. Nazarian, P.Koch and J. Schatzker, Springer-Verlag, Berlin, 1990. The OrthopaedicTrauma Association is indebted to Professor Maurice Mller for allowing theAssociation to use the system.

Correspondence: JL Marsh, MD, Department of Orthopaedics and Rehabilitation,The University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01071 JPP,Dept. of Orthopaedics, Iowa City, IA 52242 (e-mail: [email protected]).

Copyright 2007 by Lippincott Williams & Wilkins

INTRODUCTION

The purpose of this new classification compendium is torepublish the OTA classification. There are many reasons to dothis. It will further a cohesive collaboration between the OTAClassification, Database and Outcomes Committee and theArbeitsgemeinschaft fr Osteosynthesefragen ClassificationTask Force (AO/CTF) group and will publish the unified cod-ing agreed upon by the two groups (Fig. 1). This will furtherthe original goal of developing an internationally recognizeduniform means to communicate about and perform clinical re-search on fractures and dislocations. This introductory chap-ter discusses the advantages and disadvantages of the uniformclassification as it has existed for the past 10 years, reviewsnew scientific information on fracture classification, high-lights the successes that have been realized, summarizes thedrawbacks to systematic classification of fractures, and de-scribes the process the OTA Classification, Database andOutcomes Committee has gone through to modify the exist-ing classification and adopt a new uniform alpha-numericcode as proposed by the AO/CTF group.

FUNDAMENTALS OF FRACTURE CLASSIFICATION

Classification is the process by which related groups areorganized based on similarities and differences.3 It condensesthe language necessary to convey information among individ-uals with a similar understanding of the classification. Abroad and diverse topic such as fractures lends itself well tothe classification process. We all classify fractures as part ofour standard description of an injury. In describing a fracture,we identify a bone, define a region in the bone, and routinelydescribe displacement and comminution and location of frac-ture lines with respect to relevant anatomy. In these ways weare verbally classifying the fracture as we describe it. Formalclassification of fractures systematizes this descriptiveprocess and replaces words with categories and numbers orletters that convey the same information. Fracture classifica-tion allows information about fractures to be stored in a waythat facilitates comparisons among different groups or amongsimilar groups treated differently.

A good fracture classification fulfills some fundamentalobjectives. It should provide a reliable and reproduciblemeans of communication. Different observers (reliability) orthe same observer on repeated viewings (reproducibility) pre-sented with the same material (for example, a radiograph)must agree on the classification of a fracture a high percent-age of the time. If this is not the case, the classification hasfailed in its fundamental goala means to communicate in-formation based on agreed similarities and differences.

There should be clear clinical relevance for the groupswithin the classification that relate either to treatment guide-lines, to prognosis, or to risk for complications. Without clini-cal relevance there is no good reason to define and separatedifferent groups. To ensure that this relevance is present,prospective clinical research is necessary. Generally speaking,the hierarchy of a classification should proceed from less se-vere (as defined by energy of injury, difficulty of treatment, orpatient outcome) to more severe, because classification is thefundamental way to convey information about injury severity.Another type of hierarchy used in both the OTA and the AOclassification organizes fractures within a class from less to

more detailed injury descriptions. This enables a rater to uti-lize the appropriate complexity to suit his or her purposes.This characteristic is relatively unique to this classification butits utility has not been widely employed in the past 11 years.Most good fracture classifications are organized with these hi-erarchies. Ideally, a classification should be all-inclusive (allfractures within reason in a given region should be included)and mutually exclusive (a given fracture should fit in only onecategory). Finally, a classification should be logical, compre-hensible, and should not contain an unmanageable number ofcategories, a problem that ensures poor reliability.4

Many different characteristics of fractures have beenused as the basis of fracture classification systems. Most clas-sifications, such as the OTA classification, are based on theanatomic location and the morphology of the fracture.1 Thesefeatures can simply be observed or formal measurements maybe necessary. Most commonly the observations and measure-ments are made on radiographs but in some circumstances in-formation obtained on physical exam, history orintra-operative findings is considered as part of the classifica-tion process. Other features of a fracture, such as the mecha-nism of injury or associated injuries, may be used indetermining how the fracture should be classified.5 Unless theinformation necessary to classify a fracture and how this infor-mation is assessed are precisely defined, observers will use theclassification in different ways and reliability will suffer.

To serve the purposes of populating large trauma data-bases, such as those used at many major trauma centers, and toprovide a space efficient shorthand across languages, a stan-dardized alpha-numeric code for all fractures is necessary andhas always been a part of this system, another relativelyunique feature. Site-specific classifications must be replacedwith a systematic, orderly classification system that encom-passes fractures of the entire skeleton. This is absolutely nec-essary for multi center collaboration, retrospective comparisonof results, international communication and for ease of accom-plishing the task of recording information about all fractures ina trauma database. Although site-specific research is possiblewithout a comprehensive classification, the more one systemis used consistently for all purposes, the closer we come to auniform universal language for fracture care. We believe thatthis is a goal that continues to be worth pursuing and is one ofthe fundamental advances of the comprehensive classifica-tions of Mller at al2 and the OTA classification.1

ADVANTAGES OF A COMPREHENSIVECLASSIFICATION OF FRACTURES

The publication of the English edition of The Compre-hensive Classification of Fractures of Long Bones by Mller atal in 1990 and the subsequent publication of the OTA classifi-cation in the 1996 JOT compendium were landmark advancesin fracture classification compared to the state of the art thatwas current at that time.1,2 Before these publications, a system-atic classification of fractures throughout the skeleton was notavailable. Eponyms were rampantColles fracture is an exam-ple used to designate diverse patterns of distal radius fracturesvariably including intra-articular and extra-articular patterns,partial and total articular comminution, and variable amountsof angulation and displacement. Trauma databases were essen-tially not possible. Classifications were developed by individ-

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S2 2007 Lippincott Williams & Wilkins

ual investigators to suit their own purposes and were widelydisseminated not only in publications but in book chapters andother non scientific works. There was no uniform language thatrelated to injury severity. Some of the terminology of theseclassifications has now become commonplace, such as partialand total articular fractures.

The vision of Mller and colleagues and the collabora-tion of the OTA dramatically changed the field of fractureclassification.1,2 These widely adopted classifications are nowused internationally and have partially achieved a universallanguage for fracture communication. They are all-inclusivewith all bones and all fractures included, and each category,with only a very few exceptions, is mutually exclusive. Theyinclude common criteria (extra-articular, partial articular,total articular) throughout the skeleton, which makes it possi-ble for even relatively inexperienced practitioners to achievethe basics of using the classification at the type and grouplevel. However, experience has shown that this should not bepushed to an extreme because certain areas of the skeleton areamenable and others are not. For this reason, in someanatomic areas in this revision we have used criteria that areanatomically specific and clinically relevant.

Another advantage of the comprehensive classificationsis that there are clear definitions of the various groups and sub-groups. For example, the localization within a long bone is de-fined by the rule of squares to define the three areas in the bone(proximal, shaft, distal).2 This may appear simplistic, but mostother commonly used classifications do not adequately definethe fracture types or groups or even what fractures belong in theclassification. For example, the Schatzker classification is ofproximal tibia fractures but fails to define how a proximal tibiafracture should be distinguished from a shaft fracture.6

Therefore, not only is there uncertainty within the groups butexactly which fractures are chosen to be classified and whichones are not is not clearly communicated. Investigators are freeto use the classification in whatever way suits their purpose.

There have also been criticisms of the comprehensiveclassification systems and areas in which the original goalshave not been achieved. With 27 subgroups in each of theareas, it is easy to conclude that it is too complex and over-whelming for the average user. As the complexity increasesobserver reliability decreases. Although these concerns arevalid, one of the advantages of the design of this classificationis that it lends itself to use of as much or as little of the in-creasing complexity of the types, groups, and subgroups as isneeded for a given purpose or a given user. For example, re-search projects may require more detail, whereas routinedatabase entries may have less detail. Another problem is thatmany of the criteria that distinguish among groups and sub-groups may be of unknown or little clinical significance, ren-dering the complexity of the classification of minimal value.Further clinical research is necessary to refine groups intothose that have maximal clinical significance for either treat-ment techniques, risks of complications, or clinical outcomes.

FRACTURE CLASSIFICATION: ISSUES WITH OBSERVER RELIABILITY

The importance of careful scrutiny of the observer reli-ability of fracture classifications became increasingly appar-ent in the early 1990s and remains a major issue for fracture

classification. The language and assumptions we use to groupfractures was seriously questioned, and the lessons learnedcontinue to be of utmost importance today. In a 1993 publica-tion in the Journal of Bone and Joint Surgery, Siebenrock andGerber assessed the observer reliability of the Neer classifica-tion of proximal humerus fractures.7 This important classifi-cation was and still is one of the most commonly usedclassifications in fracture care. It fulfills many of the goals ofa good classification because it provides a way to communi-cate critically important information about proximal humerusfractures. Decisions on treatment and determinants of out-come are based on categories determined by defining the re-lationships between four typical fracture parts of the proximalhumerus. Unfortunately this important work demonstratedthat the observer reliability of this classification was muchpoorer than expected. This data created a wave of contro-versy, with many surgeons criticizing the data and the meth-ods. However, further publications on the Neer and manyother fracture classifications have demonstrated that the useof categorical classifications is generally not highly reliable,and that these problems must be acknowledged and the issuesthat lead to them carefully studied.812 The fact that reliabil-ity is far less than perfect in many common fracture classifi-cations is no longer a disputed issue.

The reasons for poor reliability have been extensively in-vestigated, and together these investigations constitute a signif-icant body of work produced over the past 10-14 years.Investigators have studied the effect on classification reliabilityof clinician experience,811 complex imaging studies,8,1215

traced lines on radiographs,16 multiple radiographic views,10,17

number of categories,8,1822 binary decision making,23 abilityto measure displacements,24,25 and to determine basic fractureassessments (comminuted or not; displaced or not).24 These in-vestigations have demonstrated that even under the most idealconditions with experienced clinicians, clear group definitions,and excellent imaging studies, observer disagreement still oc-curs. It can be decreased but not eliminated.

There are many reasons for observer disagreement inclassifying fractures. Some of them can be improved throughvalidated development of a classification and determining cate-gories but others present limitations to the degree that observerreliability can be achieved with categorical classifications.Observers have inherent biases based on their personal experi-ences that lead them to different conclusions on the basis of thesame information. Even without this bias they make errors suchas failing to see a fracture line that others agree is present.26

These problems are inevitable and cannot be overcome. Anotherfundamental issue is that fracture classification is in many waysan assessment of injury severity. Classifying a fracture andtherefore its severity places it within a specific category whereasin reality fracture severity occurs on a continuous spec-trum.21,27,28 Some injuries are on the border between one cate-gory and another, making observer disagreement inevitable.

Despite these issues, observer reliability is better in somecircumstances than in others and for some classifications thanfor others. Not surprisingly most studies have shown that expe-rienced clinicians usually classify fractures more reliably thanless experienced clinicians, although the effect is variable in dif-ferent studies.911 Reliability can be improved by modificationsof existing classifications or during the development of newclassifications by a systematic methodological approach.29

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2007 Lippincott Williams & Wilkins S3

Through these methods, problems that are now known to in-crease observer error and disagreement can be readily identifiedand minimized as much as possible. Categories within a classi-fication should be as discrete as possible because less discretecategories lead to wide gray zones and thus increase observerdisagreement. For example, if a category is defined by asking ifa fracture line enters the articular surface, a clear judgment canbe made. However, if the category is defined by the presence orabsence of fracture comminution, this less clear assessment(how is comminuted defined?) increases the chances for dis-agreement.24 Similarly, subjective assessments perform poorly,such as a category defined by a high energy mechanism espe-cially without definition of what this phrase means.24 To the ex-tent possible, categories should be uniquely defined. As anexample, assessing whether the physis is either involved with afracture or is not is a more uniquely defined assessment thanwhether the fracture is angulated or not. The latter leaves roomfor various interpretations of angulation. If measurements areused to define categories the degree of error in measuring mustbe considered and minimized. For example, the degree of dis-placement of the articular surface in millimeters has been shownto have high observer error, which means that this commonlyused assessment is a poor way to define categories.24,30 Somemeasurements are impossible to make. A category defined asgreater or less than 1 centimeter of displacement between frag-ments (eg, the greater tuberosity from the rest of the humerus)requests an observer to measure something on radiographs thatare often exposed in a plane that makes this measurement im-possible, relegating the assignment of a fracture category to aguess unless multiple, carefully exposed radiographs in variousdegrees of rotation are evaluated.17 Moreover, categories aresometimes defined according to a pre-defined cut-off regardinga continuous diagnostic parameter. For example, the obliquityof diaphyseal fractures is reduced to a dichotomous variable (! 30 vs " 30) in the comprehensive long bone classification.Any such cut-off values ideally should be chosen so that theyare reliably measured and clinically important, but this may notbe the case.

The Comprehensive Classification developed by Mllerat al and modified and adopted by the OTA has not been im-mune to these problems with observer reliability.1,2 Studies inthe distal radius, distal tibia, proximal tibia, proximalfemur8,1822 and elsewhere have demonstrated that the observerreliability of the system falls off significantly between the typeand group level and again at the group to subgroup level. It hasgenerally been conceded that for the purposes of clinical re-search it has excellent reliability only at the type level.20,21

NEW INITIATIVES IN CLASSIFICATION OVER 10 YEARS

There have been initiatives in fracture assessment de-signed to improve classification rather than merely to defineproblems.25 The rank order method has been used in studies inother clinical areas where categorical classification has provedto be difficult.27 To avoid problems with classification,Buckwalter et al assessed residents clinical performance byhaving faculty rank them in relation to each other and then cor-related the rankings with in-training exam scores.31 They foundhigh levels of faculty agreement for relative ranks of residentperformance indicating that the rank order method was an excel-

lent substitute for classification. As problems with categoricalclassification of fractures became apparent, rank order methodshave been applied to fractures. This method avoids the problemwith reliability that occurs when a continuous variable, such asfracture severity, is arbitrarily assigned to categories. Instead, anumber of fractures are ranked in relation to each other by ex-perienced clinicians for severity or for any variable of interest.DeCoster et al and Williams et al have demonstrated that therank order method to assess fracture severity leads to high lev-els of observer agreement in the relative rank betweencases.27,28 This indicates that observers agree on the relativeorder of injury severity but when asked to assign categories theyhave much greater disagreement. In both of these studies, therank order method was used to predict clinical outcomes.27,28

Unfortunately, this method is only amenable to use within a de-fined series of patients because the results cannot be transposedout of the series. It therefore has applicability only for researchpurposes where it can be used as a more reliable way to assignrelative severity than classification. Nork et al have recentlyused this method to assess injury severity in a series of bicondy-lar tibial plateau fractures and have applied the results to deter-mine factors that predict outcome after treatment.32

Considering the problems with previous classificationsanother new initiative in fracture classification has been devel-oped by the AO/CTF group, which has been working on sev-eral site-specific projects to develop new classifications using asystematic methodology in three phases.33 The first develop-ment phase involves clinical experts developing proposals forthe classification system, as well as defining the classificationprocess. This phase is related solely to diagnostics and definesa common language with which surgeons should be able toidentify and classify fractures similarly. Successive pilot agree-ment studies are conducted to ensure that clinical experts cando this, and if they cannot, the proposed system and classifica-tion process is appropriately changed and reevaluated. Such asystematic process has been applied for the development of apediatric long bone classification with very encouraging re-sults.34 An innovative approach using latent class modeling forthe analysis of classification data has been proposed, particu-larly when an acceptable reference standard classificationprocess is lacking.35 The second phase involves a multicenteragreement study to ensure that future users with less clinicalexperience can also classify fractures similarly. Depending onthe results, some modifications toward improvement of the sys-tem may still be proposed.36,37 This creates the basis for a reli-able classification tool to be used in the context of prospectiveclinical studies for evaluation of fracture treatment options andoutcomes in a third validation phase.

The AO/CTF group and the OTAs Classification, Data-base and Outcomes Committee are collaborating in the devel-opment, validation, and promotion of clinically relevant andwidely accepted classification systems. Internationally recog-nized classification review groups for different body sites arebeing created as an important step forward. Modifications ofnew and existing systems should be evidence-based, ie, pro-posed and supported on the basis of solid validation data.

The AO/CTF group has also integrated approved clas-sification systems into a software named AO COIAC (AOComprehensive Injury Automatic Classifier) to support teach-ing and to facilitate diagnosis and coding of injuries. A skele-ton interface provides access to one of several area-specific



Journal of Orthopaedic Trauma Volume 21, Number 10 Supplement, November/December 2007 Introduction


A Mller-AO classification system B OTA classification system

Figure 2: Proposal for a unified numbering AO/OTA system

FIGURE 1. Designation of bone location

C New unified classification system

classification modules. Drawing fracture lines or clickingwith the mouse on standard bone drawings aids the classifica-tion process for the user, with successive drop-down menusand classification options. Data can be saved in a relationaldatabase and exported for further analyses and presentations,or printed for the patients files. For each injury the classifi-cation data can be collected by several different surgeonsand/or at different times, hence supporting research and vali-dation efforts.33 The groups initial publications have been ona pediatric long bone classification.34

THE PROCESS OF REVISING THE COMPENDIUM

At the time of the original publication of the OTA classi-fication the committee classified additional bones that were not

included in the original Comprehensive Classification proposedby Mller et al.1,2 This led the committee to make some changesin the overall numeric code which over the past 10 years re-sulted in two somewhat different codes, one used by the AO andone by the OTA. For example, in the original AO system clavi-cle was 91.2 and in the OTA system it was 06, patella 91.1 AOand 34 OTA, and the wrist and hand were 7 in AO and 24, 25and 26 for OTA. In early 2006 the AO/CTF group proposed anew unified numbering scheme to replace both of the previousversions. This proposal was considered and then accepted by theClassification, Database and Outcomes Committee of the OTA.Now clavicle (15), scapula (14), patella (34), hand (7), and foot(8) will be the same for both groups. Through this agreementthere is now one universal alpha-numeric code that promotes theconcept of a universal language for fractures. The original AO

and OTA numbering schemes and the new unified numberingscheme are reproduced in Figure 1 A-C. The body of this com-pendium uses the new unified alpha-numeric code. There are nochanges to the long bone sections (humerus, radius and ulna,femur, and tibia) originally published by Mller et al,2 whichfurther promotes a unified fracture code accepted universally byboth groups.

In addition to accepting and incorporating the unifiednumbering format, other revisions of the OTA classificationwere produced with the help of member volunteers from theorganization. Members participating were asked to independ-ently review assigned sections of the classification and tomake suggestions for improvement in language, descriptions,style and format. All suggestions were collated anatomicallyand then reviewed by the Classification, Database andOutcomes Committee at a full day meeting. Committee mem-bers submitted additional suggestions. All suggestions fromthe member volunteers and committee members were individ-ually considered. Extra consideration was given to sugges-tions that were received from multiple individuals.

After discussion, if the committee unanimously agreedthat suggested revisions were improvements, they wereadopted and included in this volume. The major change that isimmediately apparent relates to format, where many memberssuggested and the committee agreed that all groups (A,B,C)should be presented on the same page rather than split as in the1996 publication. The long bone sections 14 were notchanged. The advantages of addressing difficulties with lan-guage and categories identified in these areas by OTA mem-bers and the committee were offset by the important goal offurthering a unified international fracture language. The sec-tions other than long bone (14, 15, 58) were updated. Wehave made extensive revisions to the foot and carpus.Metacarpal and metatarsal and phalanges are now exactlyaligned in both the foot and the hand. Dislocations were ex-panded on an anatomic basis and designated with a zero code

in the second digit. Dislocations will be coded separately(other than in the pelvis, forearm, and talus), and this sectionhas been completely revised.

A new part of the classification, the pediatric long boneclassification, has been incorporated directly from the workof the AO/CTF group and is the result of their meticulous sci-entific effort. We sincerely hope that future republications ofthe OTA classification will be able to incorporate additionalchanges resulting from this type of rigorous scientific methodand will therefore need to depend less on committee review.

SUMMARY

Since the original publication of the OTA FractureClassification in the 1996 JOT Compendium, there has beenimportant progress in fracture classification. We are fartheralong toward the goal of a universally accepted fracture lan-guage, but more progress remains to be made. New knowl-edge has helped us to understand how classifications work, orsometimes do not work. Much of this new knowledge hasbeen enlightening; some of it has highlighted areas in whichadditional work is necessary. Advances in fracture care arepossible only through an organized grouping of the pathologypresented by the myriad of fracture patterns and associated in-juries. Republication of the OTA classification in this com-pendium combined with advances in fracture classificationsoftware and scientific methodology by the AO/CTF group,will serve to further this goal. We hope to reinvigorate inter-est in the language we use to communicate and record infor-mation about fractures and dislocations, because it is onlythrough this language that we can collectively learn from ourexperiences to provide better care for future fracture patients.We encourage those interested in fracture care to utilize thisclassification and to participate in further classification im-provements that will lead to the publishing of yet another im-proved version 10 years from now.



Listing of references can be found on page S133.

The AO Classification Supervisory Committee welcomes theopportunity to participate with the Orthopaedic TraumaAssociation (OTA) in the revision of the Compendium onFracture Classification. The original cooperative effort on thisCompendium was started to standardize the classification sys-tem for fractures based upon the work of Maurice Mllerthrough the Comprehensive Classification of Fractures. Thecollaboration of AO with the OTA ensured that this system hasa basic worldwide readership and distribution. This opportunityto attempt to standardize the terminology for fractures and clas-sifications has now led to a revision of the Compendium to dealwith any potential change. Two major events have occurred.First, a truly validated classification for pediatric fractures isnow available. This classification has gone through two criticalstages of internal validation and evaluation and has now beenpublished in pediatric peer-reviewed journals. This is a majorlandmark in the classification literature and development, inthat a classification system has now been validated by accepted

methodology. The OTA and the AO Classification SupervisoryCommittee are continuing this work by developing a validatedscapular fracture classification. This has just begun its firststages of validation. Consequently, it will not appear in this edi-tion of the Compendium but when it has been completed, prob-ably within the next year or year and a half, it will be availableas a supplement. The OTA and AO are firm in their convictionthat all new classifications must be developed on the basis ofbroad, internationally recognized expertise and that appropriatevalidation and verification by the accepted methodology shouldbe carried out before publication and use. It is also hoped thatover the next year or two, there will be an attempt to validatethe comprehensive classification.

Dr. Theddy F. Slongo Chairman of the AO Classification Supervisory Committee Inselspital3010 Bern, Switzerland

Introductory Message from the AO Classification Supervisory Committee

BONE: HUMERUS (1) Location: Proximal segment (11)

Types:A. Extra-articular, unifocal fracture (11-A)

Groups:Humerus proximal segment, extra-articular unifocal(11-A)1. Avulsion of tuberosity(11-A1)

2. Impactedmetaphysis(11-A2)

3. Non-impactedmetaphysisfracture(11-A3)

B. Extra-articular, bifocal fracture (11-B) C. Articular fractures (11-C)

2. Withoutmetaphysealimpaction(11-B2)

2. Articularfracture im-pacted withmarked dis-placement(11-C2)

Humerus, proximal segment, extra-articular bifocal(11-B)1. With meta-physeal impaction (11-B1)

Humerus, proximal segment, articular fractures(11-C)1. Articular fracture with slight displace-ment impacted valgus fracture(11-C1)

3. Withglenohumeraldislocation(11-B3)

These fractures represent three part fractures, or frac-ture dislocations by the Neer classification.

3. Articularfracture withgleno-humeral dis-location(11-C3)

HUMERUS



Humerus J Orthop Trauma Volume 21, Number 10 Supplement, November/December 2007


Subgroups and Qualifications: Humerus, proximal, extra-articular, unifocal tuberosity (11-A1)1. Greater tuberosity not displaced(11-A1.1)

2. Greater tuberosity displaced(11-A1.2)(1) superior, (2) posterior

3. With glenohumeral dislocation(11-A1.3)(1) anterior and medial plus posteriorcephalic notch(2) anterior and medial plus greatertuberosity(3) erecta and greater tuberosity(4) posterior and lesser tuberosity

Humerus, proximal, extra-articular, unifocal, impacted metaphyseal (11-A2)1. Without frontal malalignment (11-A2.1)(1) without sagittal malalignment(2) posterior impaction(3) anterior impaction

2. With varus malalignment (11-A2.2)(1) pure medial impaction(2) posterior and medial impaction(3) anterior and medial impaction

3. With valgus malalignment(11-A2.3)(1) pure lateral impaction(2) posterior and lateral impaction(3) anterior and lateral impaction

Humerus, proximal, extra-articular, unifocal, non-impacted metaphyseal (11-A3)1. Simple with angulation (11-A3.1) 2. Simple with translation (11-A3.2)

(1) lateral(2) medial(3) with glenohumeral dislocation

3. Multifragmentary (11-A3.3)(1) wedge(2) complex(3) glenohumeral dislocation

A1

A2

A3

J Orthop Trauma Volume 21, Number 10 Supplement, November/December 2007 Humerus


Humerus, proximal, extra-articular, bifocal, with metaphyseal impaction (11-B1)1. Lateral plus greater tuberosity (11-B1.1)(1) pure lateral impaction(2) posterior and lateral impaction(3) anterior and lateral impaction

2. Medial plus lesser tuberosity(11-B1.2)(1) pure lateral impaction(2) posterior and lateral impaction(3) anterior and lateral impaction

3. Posterior plus greater tuberosity(11-B1.3)

Humerus, proximal, extra-articular, bifocal, without metaphyseal impaction (11-B2)1. Without rotatory displacement of the epiphyseal fracture fragment (11-B2.1)

2. With rotatory displacement of theepiphyseal fragment (11-B2.2)(1) greater tuberosity separated(2) lesser tuberosity separated

3. Multifragmentary metaphysis plusone of the tuberosities (11-B2.3)(1) lesser tuberosity(2) greater tuberosity

Humerus, proximal, extra-articular, bifocal with glenohumeral dislocation (11-B3)1. Vertical cervical line plus greater tuberosity intact plus anterior medial dislocation (11-B3.1)

2. Vertical cervical line plus greatertuberosity fracture plus anterior me-dial dislocation (11-B3.2)

3. Lesser tuberosity fracture plus pos-terior dislocation (11-B3.3)(1) without anterior cephalic notch(2) with anterior cephalic notch

B1

B2

B3


S10 2007 Lippincott Williams & WilkinsS10 2007 Lippincott Williams & Wilkins

2. Anatomical neck and tuberosities(11-C3.2)(1) head impacted(2) head not impacted

Humerus, proximal, articular fracture dislocated (11-C3)1. Anatomical neck (11-C3.1)(1) anterior(2) posterior

3. Cephalotubercular fragmentation(11-C3.3)(1) head intact(2) head fragmented

Humerus, proximal, articular fracture with slight displacement (11-C1)1. Cephalotubercular with valgus malalignment (11-C1.1)

2. Cephalotubercular with varusmalalignment (11-C1.2)

3. Anatomical neck (11-C1.3)(1) nondisplaced(2) displaced

Humerus, proximal, articular fracture impacted with marked displacement (11-C2)1. Cephalotubercular with valgus malalignment (11-C2.1)

2. Cephalotubercular with varusmalalignment (11-C2.2)

3. Transcephalic (double profile imageon x-ray) and tubercular, with varusmalalignment (11-C2.3)

C1

C2

C3



BONE: HUMERUS (1) Location: Diaphyseal segment (12)

Types:A. Simple fracture (12-A) B. Wedge fracture (12-B) C. Complex fracture (12-C)

Groups:Humerus diaphyseal, simple (12-A)1. Spiral (12-A1)

2. Oblique(!!30) (12-A2)

3. Transverse(""30) (12-A3)

Humerus diaphyseal, wedge (12-B)1. Spiral wedge (12-B1)

2. Bendingwedge (12-B2)

3. Frag-mentedwedge (12-B3)

Humerus diaphyseal, complex (12-C)1. Spiral (12-C1)

2. Segmental(12-C2)

3. Irregular(12-C3)



Subgroups and Qualifications: Humerus diaphyseal, simple, spiral (12-A1)1. Proximal zone (12-A1.1) 2. Middle zone (12-A1.2) 3. Distal zone (12-A1.3)

Humerus diaphyseal, simple, oblique (!!30) (12-A2)1. Proximal zone (12-A2.1) 2. Middle zone (12-A2.2) 3. Distal zone (12-A2.3)

Humerus diaphyseal, simple, transverse (""30) (12-A3)1. Proximal zone (12-A3.1) 2. Middle zone (12-A3.2) 3. Distal zone (12-A3.3)

A1

A2

A3



2. Middle zone (12-B2.2) 3. Distal zone (12-B2.3)Humerus diaphyseal, wedge, bending (12-B2)1. Proximal zone (12-B2.1)

Humerus diaphyseal, wedge, spiral (12-B1)1. Proximal zone (12-B1.1) 2. Middle zone (12-B1.2) 3. Distal zone (12-B1.3)

Humerus diaphyseal, wedge, fragmented (12-B3)1. Proximal zone (12-B3.1) 2. Middle zone (12-B3.2) 3. Distal zone (12-B3.3)

B1

B2

B3



Humerus, diaphyseal, complex irregular (12-C3)1. With 2 or 3 intermediate fragments (12-C3.1)(1) 2 main intermediate fragments(2) 3 main intermediate fragments

2. With limited shattering (""4cm)(12-C3.2)(1) proximal zone(2) middle zone(3) distal zone

3. With extensive shattering(##4cm)(12-C3.3)(1) pure diaphyseal(2) proximal diaphysio-metaphyseal(3) distal diaphysio-metaphyseal

Humerus diaphyseal, complex, spiral (12-C1)(1) pure diaphyseal(2) proximal diaphysio-metaphyseal(3) distal diaphysio-metaphyseal1. With 2 intermediate fragments (12-C1.1)

2. With 3 intermediate fragments (12-C1.2)

3. With more than 3 intermediatefragments (12-C1.3)

Humerus, diaphyseal, complex segmental (12-C2)1. With 1 intermediate segmental fragment (12-C2.1)(1) pure diaphyseal(2) proximal diaphysio-metaphyseal(3) distal diaphysio-metaphyseal(4) oblique lines(5) transverse and oblique lines

2. With 1 intermediate segmental andadditional wedge fragments (12-C2.2)(1) pure diaphyseal(2) proximal diaphysio-metaphyseal(3) distal diaphysio-metaphyseal(4) distal wedge(5) 2 wedges, proximal and distal

3. With 2 intermediate segmentalfragments (12-C2.3)(1) pure diaphyseal(2) proximal diaphysio-metaphyseal(3) distal diaphysio-metaphyseal

C1

C2

C3



BONE: HUMERUS (1) Location: Distal segment (13)

Types:A. Extra-articular fracture (13-A) B. Partial articular fracture (13-B) C. Complete articular fracture (13-C)

2. Meta-physealsimple (13-A2)

3. Meta-physeal multi-fragmentary(13-A3)

Groups:Humerus distal segment, extra-articular (13-A)1. Apophyseal avulsion (13-A1)

Humerus distal segment, partial articular (13-B)1. Lateral sagittal (13-B1)

2. Medialsagittal (13-B2)

3. Frontal (13-B3)Humerus distal segment, complete articular (13-C)1. Articular simple, metaphyseal simple (13-C1)

2. Articularsimple, meta-physeal multi-fragmentary(13-C2)

3. Articular,metaphysealmultifragmen-tary (13-C3)



Subgroups and Qualifications: Humerus, distal, extra-articular apophyseal avulsion (13-A1)1. Lateral epicondyle (13-A1.1) 2. Medial epicondyle, non-incarcerated

(13-A1.2)(1) non-displaced(2) displaced(3) fragmented

3. Medial epicondyle, incarcerated(13-A1.3)

Humerus, distal, extra-articular metaphyseal simple (13-A2)1. Oblique downwards and inwards (13-A2.1)

2. Oblique down-wards and outwards(13-A2.2)

3. Transverse (13-A2.3)(1) transmetaphyseal (2) juxta-epiphyseal

with posterior displace-ment (Kocher I)

(3) juxta-epiphysealwith anterior displace-ment (Kocher II)

Humerus, distal, extra-articular metaphyseal multifragmentary (13-A3)1. With intact wedge (13-A3.1)(1) lateral(2) medial

2. With fragmented wedge (13-A3.2)(1) lateral(2) medial

3. Complex (13-A3.3)

A1

A2

A3



Humerus, distal, partial articular lateral sagittal (13-B1)1. Capitellum (13-B1.1)(1) through the capitellum (Milch I)(2) between capitellum and trochlea

2. Transtrochlear simple (13-B1.2)(1) medial collateral ligament intact(2) medial collateral ligament ruptured(3) metaphyseal simple (classic Milch II)lateral condyle(4) metaphyseal wedge(5) metaphysio-diaphyseal

3. Transtrochlear multifragmentary(13-B1.3)(1) epiphysio-metaphyseal(2) epiphysio-metaphyseal-diaphyseal

Humerus, distal, partial articular, medial sagittal (13-B2)1. Transtrochlear simple, through medial side (Milch I) (13-B2.1)

2. Transtrochlear simple, through thegroove (13-B2.2)

3. Transtrochlear multifragmentary(13-B2.3)(1) epiphysio-metaphyseal(2) epiphysio-metaphyseal-diaphyseal

Humerus, distal, partial articular, frontal (13-B3)1. Capitellum (13-B3.1)(1) incomplete (Kocher-Lorenz)(2) complete (Hahn-Steinthal 1)(3) with trochlear component (Hahn-Steinthal 2)(4) fragmented

2. Trochlea (13-B3.2)(1) simple(2) fragmented

3. Capitellum and trochlea (13-B3.3)

B1

B2

B3



Humerus, distal, complete multifragmentary (13-C3)1. Metaphyseal simple (13-C3.1) 2. Metaphyseal wedge (13-C3.2)

(1) intact(2) fragmented

3. Metaphyseal complex (13-C3.3)(1) localized(2) extending into diaphysis

Humerus, distal complete, articular simple, metaphyseal simple (13-C1)1. With slight displacement (13-C1.1)(1) Y-shaped(2) T-shaped(3) V-shaped

2. With marked displacement(13-C1.2)(1) Y-shaped(2) T-shaped(3) V-shaped

3. T-shaped epiphyseal (13-C1.3)

Humerus, distal, complete articular simple metaphyseal multifragmentary (13-C2)1. With intact wedge (13-C2.1)(1) metaphyseal lateral(2) metaphyseal medial(3) metaphysio-diaphyseal-lateral(4) metaphysio-diaphyseal-medial

2. With a fragmented wedge (13-C2.2)(1) metaphyseal lateral(2) metaphyseal medial(3) metaphysio-diaphyseal-lateral(4) metaphysio-diaphyseal-medial

3. Complex (13-C2.3)

C1

C2

C3

BONE: RADIUS/ULNA (2) Location: Proximal segment (21)

Types:A. Extra-articular (21-A)

Groups:Radius/ulna, proximal, extra-articular (21-A)

1. Ulna only(21-A1)

2. Radius only(21-A2)

3. Radius andulna (21-A3)

B. Articular fracture involving articularsurface of only 1 of the 2 bones (21-B)

C. Articular fracture involving artic-ular surface of 2 bones (21-C)

2. Radius frac-tured, ulna in-tact (21-B2)

2. Simple of1, multifrag-mentary ofother (21-C2)

Radius/ulna, proximal, articular surface one bone(21-B)1. Ulna fractured, radius intact(21-B1)

Radius/ulna, proximal, articular both bones (21-C)

1. Simple of both bones (21-C1)

3. Articular of1 bone, extra-articular ofother (21-B3)

3. Multifrag-mentary ofboth (21-C3)

RADIUS/ULNA



Radius/Ulna J Orthop Trauma Volume 21, Number 10 Supplement, November/December 2007


Subgroups and Qualifications:Radius/ulna, proximal, extra-articular ulna fractured (21-A1)1. Avulsion of triceps insertion from olecranon (21-A1.1)

2. Metaphyseal simple (21-A1.2) 3. Metaphyseal multifragmentary(21-A1.3)

Radius/ulna, proximal, extra-articular radius fractured (21-A2)1. Avulsion of bicipital tuberosity of radius (21-A2.1)

2. Neck simple (21-A2.2) 3. Neck multifragmentary (21-A2.3)

Radius/ulna, proximal, extra-articular, fracture both bones (21-A3)1. Simple of both bones (21-A3.1) 2. Multifragmentary of 1 bone and

simple of other (21-A3.2)(1) multifragmentary ulna(2) multifragmentary radius

3. Multifragmentary of both bones(21-A3.3)

A1

A2

A3

J Orthop Trauma Volume 21, Number 10 Supplement, November/December 2007 Radius/Ulna


Radius/ulna, proximal, articular, radial fracture (21-B2)1. Simple (21-B2.1)(1) nondisplaced(2) displaced

2. Multifragmentary without depres-sion (21-B2.2)

3. Multifragmentary with depression(21-B2.3)

Radius/ulna, proximal, articular fracture ulna (21-B1)1. UnifocaI (21-B1.1)(1) olecranon 1 line(2) olecranon 2 lines(3) olecranon multifragmentary(4) coronoid process alone

2. Bifocal (21-B1.2) 3. Bifocal multifragmentary (21-B1.3)(1) multifragmentary olecranon(2) multifragmentary coronoid process(3) multifragmentary of both

Radius/ulna, proximal, articular of 1, extra-articular of other (21-B3)1. Ulna articular simple (21-B3.1)(1) radius extra-articular simple(2) radius extra-articular multifragmentary

2. Radius articular simple (21-B3.2)(1) ulna extra-articular simple(2) ulna extra-articular multifragmentary

3. Articular multifragmentary(21-B3.3)(1) ulna, radius extra-articular simple(2) ulna, radius extra-articular multifrag-mentary(3) radius, ulna extra-articular simple(4) radius, ulna extra-articular multifrag-mentary

B1

B2

B3



2. Ulna, more than 3 fragments(21-C3.2)(1) radius, 3 fragments(2) radius, more than 3 fragments

Radius/ulna, proximal, articular multifragmentary both bones (21-C3)1. 3 fragments both bones (21-C3.1) 3. Radius, more than 3 fragments

(21-C3.3)(1) ulna, 3 fragments(2) ulna, epiphysio-diaphyseal

Radius/ulna, proximal, articular both simple (21-C1)1. Olecranon and radial head(21-C1.1)

2. Coronoid process and radial head(21-C1.2)

Radius/ulna, proximal, articular, both bones, 1 simple the other multifragmentary (21-C2)1. Olecranon multifragmentary, radial head, simple (21-C2.1)

2. Olecranon simple, radial head multi-fragmentary (21-C2.2)

3. Coronoid process simple, radialhead multifragmentary (21-C2.3)

C1

C2

C3



BONE: RADIUS/ULNA (2) Location: Diaphyseal (22)

Types:A. Simple (22-A) B. Wedge (22-B) C. Complex (22-C)

Groups:Radius/ulna, diaphyseal, simple (22-A)1. Ulna simple, radius intact(22-A1)

2. Radius sim-ple, ulna intact(22-A2)

3. Simple frac-ture bothbones (22-A3)

Radius/ulna, diaphyseal, wedge fracture (22-B)1. Ulna fracture, radius intact(22-B1)

2. Radius frac-ture, ulna in-tact (22-B2)

3. Wedgefracture, sim-ple or wedgeof other bone(22-B3)

Radius/ulna, diaphyseal, complex (22-C)1. Complex of ulna (22-C1)

2. Complex ofradius (22-C2)

3. Complex ofboth bones(22-C3)



Subgroups and Qualifications:Radius/ulna, diaphyseal, simple fracture of ulna (22-A1) 1. Oblique (22-A1.1) 2. Transverse (22-A1.2) 3. With dislocation of radial head

(Monteggia) (22-A1.3)

Radius/ulna, diaphyseal, simple fracture of radius (22-A2)1. Oblique (22-A2.1) 2. Transverse (22-A2.2) 3. With dislocation of distal radio-

ulnar joint (Galeazzi) (22-A2.3)

Radius/ulna, diaphyseal, simple fracture of both bones (22-A3)(1) without dislocation(2) with dislocation of radial head (Monteggia)(3) with dislocation of distal radioulnar joint (Galeazzi)(based on level of radial fracture)1. Radius, proximal zone (22-A3.1) 2. Radius, middle zone (22-A3.2) 3. Radius, distal zone (22-A3.3)

A1

A2

A3



Radius/ulna, diaphyseal, wedge fracture of ulna (22-B1)1. Intact wedge (22-B1.1) 2. Fragmented wedge (22-B1.2) 3. With dislocation of radial head

(Monteggia) (22-B1.3)

2. Fragmented wedge (22-B2.2) 3. With dislocation of distal radio-ulnar joint (Galeazzi) (22-B2.3)

Radius/ulna, diaphyseal, wedge fracture of radius (22-B2)1. Intact wedge (22-B2.1)

Radius/ulna, diaphyseal, wedge of 1, simple or wedge of other (22-B3)(1) without dislocation(2) with dislocation of radial head (Monteggia)(3) with dislocation of distal radioulnar joint (Galeazzi)1. Ulna wedge, simple fracture radius(22-B3.1)

2. Radial wedge, simple fracture ofulna (22-B3.2)

3. Radial and ulnar wedge (22-B3.3)

B1

B2

B3



Radius/ulna, diaphyseal, complex of both bones (22-C3)1. Bifocal (22-C3.1) 2. Bifocal of 1, irregular of other

(22-C3.2)(1) bifocal radius, irregular ulna(2) bifocal ulna, irregular radius

3. Irregular (22-C3.3)

Radius/ulna, diaphyseal, complex fracture of ulna (22-C1)1. Bifocal, radius intact (22-C1.1)(1) without dislocation(2) with radial head dislocated (Monteggia)

2. Bifocal with radial fracture (22-C1.2)(1) radius simple(2) radius wedge

3. Irregular of ulna (22-C1.3)(1) radius intact(2) radius simple(3) radius wedge

Radius/ulna, diaphyseal, complex fracture of radius (22-C2)1. Bifocal, ulna intact (22-C2.1)(1) without dislocation(2) with dislocation of distal radioulnar joint (Galeazzi)

2. Bifocal, ulna fracture (22-C2.2)(1) simple ulna(2) wedge ulna

3. Irregular (22-C2.3)(1) ulna intact(2) ulna simple(3) ulna wedge

C1

C2

C3



BONE: RADIUS/ULNA (2) Location: Distal segment (23)

Types:A. Extra-articular (23-A) B. Partial articular fracture of radius (23-B) C. Complete articular fracture of ra-

dius (23-C)

2. Extra-artic-ular simpleradius frac-ture, ulnaintact (23-A2)

3. Extra-articu-lar, multifrag-mentaryradius fracture(23-A3)

Groups:Radius/ulna, distal, extra-articular (23-A)1. Extra-articular ulna fracture, radius intact(23-A1)

Radius/ulna, distal, partial articular radius (23-B)1. Partial articular radius, sagittal (23-B1)

2. Partial artic-ular radius,dorsal rim(Barton)(23-B2)

3. Partial articularradius, volar rim(reverse Barton,Goyrand SmithII) (23-B3)

Radius/ulna, distal, complete articular (23-C)1. Complete articular radius, simple articular and metaphysis(23-C1)

2. Completearticular ra-dius, simplearticular,metaphysealmultifragmen-tary (23-C2)

3. Completearticular ra-dius, multi-fragmentary(23-C3)



Subgroups and Qualifications:Radius/ulna, distal, extra-articular fracture of ulna (23-A1)1. Ulna styloid process (23-A1.1) 2. Metaphyseal simple (23-A1.2) 3. Metaphyseal multifragmentary

(23-A1.3)(1) wedge(2) complex

Radius/ulna, distal, extra-articular fracture of radius, simple metaphyseal and impacted (23-A2)(1) radioulnar dislocation (fracture of styloid process)(2) simple fracture of ulnar neck(3) multifragmentary fracture of ulnar neck(4) fracture of ulna head(5) fracture of ulna head and neck(6) fracture proximal to ulnar neck1. Transverse, no tilt, but may be axially shortened (23-A2.1)

2. With dorsal tilt, oblique fracture up-ward and back (Pouteau-Colles)(23-A2.2)

3. Volar tilt, oblique upwards and for-ward (Goyrand-Smith) (23-A2.3)

Radius/ulna, distal, extra-articular fracture of radius, multifragmentary (23-A3)(1) radioulnar dislocation (fracture of styloid process)(2) simple fracture of ulnar neck(3) multifragmentary fracture of ulnar neck(4) fracture of ulna head(5) fracture of ulna head and neck(6) fracture proximal to ulnar neck1. Impacted with axial shortening(23-A3.1)

2. With a wedge (23-A3.2) 3. Complex (23-A3.3)

A1

A2

A3



Radius/ulna, distal, partial articular fracture of radius, sagittal (23-B1)(1) radioulnar dislocation (fracture of styloid process)(2) simple fracture of ulnar neck(3) multifragmentary fracture of ulnar neck(4) fracture of ulna head(5) fracture of ulna head and neck(6) fracture proximal to ulnar neck1. Lateral simple (23-B1.1) 2. Lateral multifragmentary (23-B1.2) 3. Medial (23-B1.3)

Radius/ulna, distal, partial articular fracture of radius, dorsal rim (Bartons) (23-B2)(1) radioulnar dislocation (fracture of styloid process)(2) simple fracture of ulnar neck(3) multifragmentary fracture of ulnar neck(4) fracture of ulna head(5) fracture of ulna head and neck(6) fracture proximal to ulnar neck1. Simple (23-B2.1) 2. With lateral sagittal fracture

(23-B2.2)3. With dorsal dislocation of carpus(23-B2.3)

Radius/ulna, distal, partial articular fracture of radius, volar rim (reverse Bartons, Goyrand-Smith II) (23-B3)(1) radioulnar dislocation (fracture of styloid process)(2) simple fracture of ulnar neck(3) multifragmentary fracture of ulnar neck(4) fracture of ulna head(5) fracture of ulna head and neck(6) fracture proximal to ulnar neck1. Simple with small fragment(23-B3.1)

2. Simple with larger fragment(23-B3.2)

3. Multifragmentary (23-B3.3)

B1

B2

B3



Radius/ulna, distal, complete articular fracture of radius, multifragmentary (23-C3)(1) radioulnar dislocation (fracture of styloid process)(2) simple fracture of ulnar neck(3) multifragmentary fracture of ulnar neck(4) fracture of ulna head(5) fracture of ulna head and neck(6) fracture proximal to ulnar neck1. Metaphyseal simple (23-C3.1) 2. Metaphyseal multifragmentary

(23-C3.2)3. Extending into diaphysis (23-C3.3)

Radius/ulna, distal, complete articular fracture of radius, articular simple, metaphyseal multifragmentary (23-C2)(1) radioulnar dislocation (fracture of styloid process)(2) simple fracture of ulnar neck(3) multifragmentary fracture of ulnar neck(4) fracture of ulna head(5) fracture of ulna head and neck(6) fracture proximal to ulnar neck1. Sagittal articular fracture line(23-C2.1)

2. Frontal articular fracture line(23-C2.2)

3. Extending into diaphysis (23-C2.3)

Radius/ulna, distal, complete articular fracture of radius, articular simple, metaphyseal simple (23-C1)(1) radioulnar dislocation (fracture of styloid process)(2) simple fracture of ulnar neck(3) multifragmentary fracture of ulnar neck(4) fracture of ulna head(5) fracture of ulna head and neck(6) fracture proximal to ulnar neck1. Posteromedial articular fragment(23-C1.1)

2. Sagittal articular fracture line(23-C1.2)

3. Frontal articular fracture line(23-C1.3)

C1

C2

C3

BONE: FEMUR (3) Location: Proximal segment (31)

Types:A. Trochanteric area (31-A)

Groups:Femur, proximal trochanteric (31-A)1. Pertro-chanteric simple(31-A1)

2. Pertro-chantericmultifrag-mentary(31-A2)

3. Intertro-chanteric(31-A3)

B. Neck fractures (31-B) C. Head fractures (31-C)

2. Transcer-vical (31-B2)

2. With de-pression(31-C2)

Femur, proximal, neck fracture (31-B)1. Subcapital with slight displacement(31-B1)

Femur, proximal, head fracture (31-C)1. Split (31-Cl)3. Subcapital

with markeddisplacement(31-B3)

3. With neckfracture(31-C3)

FEMUR



Femur J Orthop Trauma Volume 21, Number 10 Supplement, November/December 2007


Subgroups and Qualifications:Femur, proximal, pertrochanteric simple (only 2 fragments) (31-A1) 1. Along intertrochanteric line(31-A1.1)

2. Through the greater trochanter (31-A1.2)(1) nonimpacted(2) impacted

3. Below lesser trochanter (31-A1.3)(1) high variety, medial fracture line atlower limit of lesser trochanter(2) low variety, medial fracture line in di-aphysis below lesser trochanter

Femur proximal, trochanteric fracture, pertrochanteric multifragmentary (always have posteromedial fragment with lessertrochanter and adjacent medial cortex) (31-A2)1. With 1 intermediate fragment(31-A2.1)

2. With several intermediate frag-ments (31-A2.2)

3. Extending more than 1 cm belowlesser trochanter (31-A2.3)

Femur, proximal, trochanteric area, intertrochauteric fracture (31-A3)1. Simple oblique (31-A3.1) 2. Simple transverse (31-A3.2) 3. Multifragmentary (31-A3.3)

(1) extending to greater trochanter(2) extending to neck

A1

A2

A3

J Orthop Trauma Volume 21, Number 10 Supplement, November/December 2007 Femur


Femur, proximal, neck fracture, transcervical (31-B2)1. Basicervical (31-B2.1) 2. Midcervical adduction (31-B2.2) 3. Midcervical shear (31-B2.3)

Femur, proximal, neck fracture, slight displacement (31-B1)1. Impacted in valgus 15(31-B1.1) (Garden 1)(1) posterior tilt 15(2) posterior tilt 15

2. Impacted in valgus 15(31-B1.2) (Garden 1/2)(1) posterior tilt 15(2) posterior tilt 15

3. Nonimpacted (31-B1.3) (Garden 2)

Femur, proximal, neck fracture, sub-capital, nonimpacted displaced (31-B3)1. Moderate displacement in varus and external rotation (31-B3.1) (Garden 3)

2. Moderate displacement with verti-cal translation and external rotation(31-B3.2) (Garden 4)

3. Marked displacement (31-B3.3)(Garden 3/4)(1) in varus(2) with translation

B1

B2

B3



2. Split and subcapital neck fracture(31-C3.2)

Femur, proximal, head fracture with neck fracture (31-C3) 1. Split and transcervical neck fracture(31-C3.1)

3. Depression and neck fracture (31-C3.3)

Femur, proximal, head fracture, with depression (31-C2)1. Posterior and superior (31-C2.1) 2. Anterior and superior (31-C2.2) 3. Split depression (31-C2.3)

Femur, proximal, head fracture, split (31-C1)1. Avulsion of ligamentum teres (31-C1.1)

2. With rupture of ligamentum teres(31-C1.2)

3. Large fragment (31-C1.3)

C1

C2

C3



BONE: FEMUR (3) Location: Diaphyseal segment (32)


Groups:Femur, diaphyseal, simple fracture (32-A)1. Spiral (32-A1) 2. Oblique

(30) (32-A2)3. Transverse(30) (32-A3)

Femur, diaphyseal, wedge fracture (32-B)1. Spiral wedge(32-B1)


3. Fragmentedwedge (32-B3)

Femur, diaphyseal, complex (32-C)1. Spiral (32-C1) 2. Segmental

(32-C2)3. Irregular(32-C3)



Subgroups and Qualifications:Femur, diaphyseal, simple spiral (32-A1)1. Subtrochanteric zone (32-A1.1) 2. Middle zone (32-A1.2) 3. Distal zone (32-A1.3)

Femur, diaphyseal, simple oblique (30) (32-A2)1. Subtrochanteric zone (32-A2.1) 2. Middle zone (32-A2.2) 3. Distal zone (32-A2.3)

Femur, diaphyseal, transverse (30) (32-A3)1. Subtrochanteric zone (32-A3.1) 2. Middle zone (32-A3.2) 3. Distal zone (32-A3.3)

A1

A2

A3



Femur, diaphyseal, wedge spiral (32-B1)1. Subtrochanteric zone (32-B1.1) 2. Middle zone (32-B1.2) 3. Distal zone (32-B1.3)

2. Middle zone (32-B2.2) 3. Distal zone (32-B2.3)Femur, diaphyseal, wedge, bending (32-B2)1. Subtrochanteric zone (32-B2.1)

Femur, diaphyseal, wedge fragmented (32-B3)1. Subtrochanteric zone (32-B3.1) 2. Middle zone (32-B3.2) 3. Distal zone (32-B3.3)

B1

B2

B3



Femur, diaphyseal, complex irregular (32-C3)1. With 2 or 3 intermediate fragments(32-C3.1)(1) 2 main intermediate fragments(2) 3 main intermediate fragments

2. With limited shattering (5cm)(32-C3.2)(1) proximal zone(2) middle zone(3) distal zone

3. With extensive shattering (5cm)(32-C3.3)(1) pure diaphyseal(2) proximal diaphysio-metaphyseal(3) distal diaphysio-metaphyseal

Femur, diaphyseal, complex spiral (32-C1)(1) pure diaphyseal(2) proximal diaphysio-metaphyseal(3) distal diaphysio-metaphyseal1. With 2 intermediate fragments(32-C1.1)

2. With 3 intermediate fragments(32-C1.2)


Femur, diaphyseal, complex segmental (32-C2)1. With 1 intermediate segmental fracture (32-C2.1)(1) pure diaphyseal(2) proximal diaphysio-metaphyseal(3) distal diaphysio-metaphyseal(4) oblique lines(5) transverse and oblique lines

2. With 1 intermediate segmental andadditional wedge fragments (32-C2.2)(1) pure diaphyseal(2) proximal diaphysio-metaphyseal(3) distal diaphysio-metaphyseal(4) distal wedge(5) 2 wedges, proximal and distal


C1

C2

C3



BONE: FEMUR (3) Location: Distal segment (33)

Types:A. Extra-articular (33-A) B. Partial articular (33-B) C. Complete articular (33-C)

Groups:Femur, distal, extra-articular (33-A)1. Simple (33-A1)

2. Meta-physealwedge (33-A2)

3. Metaphyseal complex (33-A3)

2. Medialcondyle,sagittal(33-B2)


Femur, distal, partial articular (33-B)1. Lateral condyle, sagittal (33-B1)

Femur, distal, complete articular (33-C)1. Articular simple, meta-physeal simple (33-C1)

3. Frontal(33-B3)

3. Multifrag-mentaryarticular fracture(33-C3)



Subgroups and Qualifications:Femur, distal, extra-articular simple (33-A1)1. Apophyseal (33-A1.1)(1) avulsion lateral epicondyle(2) avulsion medial epicondyle

2. Metaphyseal oblique or spiral(33-A1.2)

3. Metaphyseal transverse (33-A1.3)

Femur, distal, extra-articular, metaphyseal wedge (33-A2)1. Intact wedge (33-A2.1)(1) lateral(2) medial

2. Fragmented lateral (33-A2.2) 3. Fragmented medial (33-A2.3)

Femur, distal, extra-articular, metaphyseal complex (33-A3)1. With an intermediate split segment(33-A3.1)

2. Irregular limited to metaphysis(33-A3.2)

3. Irregular extending to diaphysis(33-A3.3)

A1

A2

A3



Femur, distal, partial articular, lateral condyle, sagittal (33-B1)1. Simple through the notch (33-B1.1) 2. Simple through load bearing sur-

face (33-B1.2)3. Multifragmentary (33-B1.3)

Femur, distal, partial articular, medial condyle, sagittal (33-B2)1. Simple through notch (33-B2.1) 2. Simple through load bearing sur-

face (33-B2.2)3. Multifragmentary (33-B2.3)

Femur, distal, partial articular, frontal (33-B3)1. Anterior and lateral flake fracture(33-B3.1)

2. Unicondylar posterior (Hoffa)(33-B3.2)(1) lateral(2) medial

3. Bicondylar posterior (33-B3.3)

B1

B2

B3



Femur, distal, complete articular, articular multifragmentary (33-C3)1. Metaphyseal simple (33-C3.1) 2. Metaphyseal multifragmentary

(33-C3.2)3. Metaphysio-diaphyseal multifrag-mentary (33-C3.3)

Femur, distal, complete articular, articular simple, metaphyseal simple (33-C1)1. T- or Y-shaped with slight displace-ment (33-C1.1)

2. T- or Y-shaped with marked dis-placement (33-C1.2)

3. T-shaped epiphyseal (33-C1.3)

Femur, distal, complete articular, articular simple, metaphyseal multifragmentary (33-C2)1. With intact wedge (33-C2.1)(1) lateral(2) medial

2. With fragmented wedge (33-C2.2)(1) lateral(2) medial


C1

C2

C3

BONE: TIBIA/FIBULA (4) Location: Proximal segment (41)

Types:A. Extra-articular (41-A)

Groups:Tibia/fibula, proximal, extra-articular (41-A)1. Avulsion(41-A1)

2. Metaphy-seal simple(41-A2)

3. Metaphysealmultifragmen-tary (41-A3)

B. Partial articular (41-B) C. Complete articular (41-C)

2. Pure de-pression(41-B2)


Tibia/fibula, proximal, partial articular (41-B)1. Pure split(41-B1)

Tibia/fibula, proximal, complete articular (41-C)1. Articular simple, meta-physeal simple(41-C1)

3. Split de-pression(41-B3)

3. Articularmultifrag-mentary(41-C3)

TIBIA/FIBULA



Tibia/Fibula J Orthop Trauma Volume 21, Number 10 Supplement, November/December 2007


Subgroups and Qualifications:Tibia/fibula, proximal, extra-articular, avulsion (41-A1)1. Of fibular head (41-A1.1) 2. Of tibial tuberosity (41-A1.2) 3. Of cruciate insertion (41-A1.3)

(1) anterior(2) posterior

Tibia/fibula, proximal, extra-articular, simple metaphysis (41-A2)1. Oblique in frontal plane (41-A2.1) 2. Oblique in sagittal plane (41-A2.2) 3. Transverse (41-A2.3)

Tibia/fibula, proximal, extra-articular, multifragmentary metaphysis (41-A3)1. Intact wedge (41-A3.1)(1) lateral(2) medial

2. Fragmented wedge (41-A3.2)(1) lateral(2) medial

3. Complex (41-A3.3)(1) slightly displaced(2) significantly displaced

A1

A2

A3

J Orthop Trauma Volume 21, Number 10 Supplement, November/December 2007 Tibia/Fibula


Tibia/fibula, proximal, partial articular, depression (41-B2)1. Lateral total (41-B2.1)(1) 1 piece(2) mosaic-like

2. Lateral limited (41-B2.2)(1) peripheral(2) central(3) anterior(4) posterior

3. Medial (41-B2.3)(1) central(2) anterior(3) posterior(4) total

Tibia/fibula, proximal, partial articular, split (41-B1)1. Of lateral surface (41-B1.1)(1) marginal(2) sagittal(3) frontal anterior(4) frontal posterior

2. Of medial surface (41-B1.2)(1) marginal(2) sagittal(3) frontal anterior(4) frontal posterior

3. Oblique, involving the tibial spinesand 1 of the surfaces (41-B1.3)(1) lateral(2) medial

Tibia/fibula, proximal, partial articular, split depression (41-B3)1. Lateral (41-B3.1)(1) antero-lateral depression(2) postero-lateral depression(3) antero-medial depression(4) postero-medial depression

2. Medial (41-B3.2)(1) antero-lateral depression(2) postero-lateral depression(3) antero-medial depression(4) postero-medial depression

3. Oblique involving the tibial spinesand 1 of the surfaces (41-B3.3)(1) lateral(2) medial

B1

B2

B3



2. Medial (41-C3.2)

Tibia/fibula, proximal, complete articular, articular multifragmentary (41-C3)(1) metaphyseal simple(2) metaphyseal lateral wedge(3) metaphyseal medial wedge(4) metaphyseal complex(5) metaphysio-diaphyseal complex1. Lateral (41-C3.1) 3. Lateral and medial (41-C3.3)

Tibia/fibula, proximal, complete articular, simple articular, simple metaphysis (41-C1)(1) intact anterior tibial tubercle and intercondylar eminence(2) anterior tibial tubercle involved(3) intercondylar eminence involved1. Slight displacement (41-C1.1) 2. 1 condyle displaced (41-C1.2) 3. Both condyles displaced (41-C1.3)

Tibia/fibula, proximal, complete articular, articular simple, metaphysis multifragmentary (41-C2)1. Intact wedge (41-C2.1)(1) lateral(2) medial

2. Fragmented wedge (41-C2.2)(1) lateral(2) medial


C1

C2

C3



BONE: TIBIA/FIBULA (4) Location: Diaphyseal segment (42)


Groups:Tibia/fibula, diaphyseal, simple (42-A)1. Spiral (42-A1) 2. Oblique

(30) (42-A2)3. Transverse(30)(42-A3)

Tibia/fibula, diaphyseal, wedge (42-B)1. Spiral wedge(42-B1)


3. Frag-mentedwedge (42-B3)

Tibia/fibula, diaphyseal, complex (42-C)1. Spiral(42-C1)

2. Segmented(42-C2)

3. Irregular(42-C3)



Subgroups and Qualifications:Tibia/fibula, diaphyseal, simple, spiral (42-A1)(1) proximal zone(2) middle zone(3) distal zone1. Fibula intact (42-A1.1) 2. Fibula fracture at different level

(42-A1.2)3. Fibula fracture at same level(42-A1.3)

Tibia/fibula, diaphyseal, simple, oblique (30) (42-A2)(1) proximal zone(2) middle zone(3) distal zone1. Fibula intact (42-A2.1) 2. Fibula fracture at different level

(42-A2.2)3. Fibula fracture at same level(42-A2.3)

Tibia/fibula, diaphyseal, simple, transverse (



Tibia/fibula, diaphyseal, wedge, spiral (42-B1)(1) proximal zone(2) middle zone(3) distal zone1. Fibula intact (42-B1.1) 2. Fibula fracture at different level

(42-B1.2)3. Fibula fracture at same level(42-B1.3)

2. Fibula fracture at different level(42-B2.2)

3. Fibula fracture at same level(42-B2.3)

Tibia/fibula, diaphyseal, wedge, bending (42-B2)(1) proximal zone(2) middle zone(3) distal zone1. Fibula intact (42-B2.1)

Tibia/fibula, diaphyseal, wedge fragmented (42-B3)(1) proximal zone(2) middle zone(3) distal zone1. Fibula intact (42-B3.1) 2. Fibula fracture at different level

(42-B3.2)3. Fibula fracture at same level(42-B3.3)

B1

B2

B3



Tibia/fibula, diaphyseal, complex, irregular (42-C3)1. With 2 or 3 intermediate fragments(42-C3.1)(1) 2 intermediate fragments(2) 3 intermediate fragments

2. Limited shattering (4cm)(42-C3.2)

3. Extensive shattering (4cm)(42-C3.3)(1) pure diaphyseal(2) proximal diaphysio-metaphyseal(3) distal diaphysio-metaphyseal

Tibia/fibula, diaphyseal, complex, spiral (42-C1)(1) pure diaphyseal(2) proximal diaphysio-metaphysis(3) distal diaphysio-metaphysis1. With 2 intermediate fragments(42-C1.1)

2. With 3 intermediate fragments(42-C1.2)


Tibia/fibula, diaphyseal, complex segmental (42-C2)1. With an intermediate segmental fragment (42-C2.1)(1) pure diaphyseal(2) proximal diaphysio-metaphyseal(3) distal diaphysio-metaphyseal(4) oblique lines(5) transverse and oblique lines

2. With an intermediate segmentaland additional wedge fragment(s)(42-C2.2)(1) pure diaphyseal(2) proximal diaphysio-metaphyseal(3) distal diaphysio-metaphyseal(4) distal wedge(5) 3 wedges, proximal and distal


C1

C2

C3



BONE: TIBIA/FIBULA (4) Location: Distal segment (43)

Types:A. Extra-articular (43-A) B. Partial articular (43-B) C. Complete articular (43-C)

2. Metaphy-seal wedge(43-A2)

3. Metaphy-seal complex(43-A3)

Groups:Tibia/fibula, distal, extra-articular (43-A)1. Metaphyseal simple (43-A1)

Tibia/fibula, distal, partial articular (43-B)1. Pure split(43-B1)

2. Split de-pression(43-B2)

3. Multifragmen-tary depression(43-B3)

Tibia/fibula, distal, complete articular (43-C)1. Articular simple, meta-physis simple(43-C1)

2. Articularsimple, meta-physis multi-fragmentary(43-C2)

3. Articularmultifragmen-tary (43-C3)



Subgroups and Qualifications:Tibia/fibula, distal, extra-articular, simple (43-A1)(1) fibula intact(2) simple fracture of fibula(3) multifragmentary fracture of fibula(4) bifocal fracture of fibula1. Spiral (43-A1.1) 2. Oblique (43-A1.2) 3. Transverse (43-A1.3)

Tibia/fibula, distal, extra-articular, wedge (43-A2)(1) fibula intact(2) simple fracture of fibula(3) multifragmentary fracture of fibula(4) bifocal fracture of fibula1. Posterolateral impaction (43-A2.1) 2. Anteromedial wedge (43-A2.2) 3. Extending into diaphysis (43-A2.3)

Tibia/fibula, distal, extra-articular, complex (43-A3)(1) fibula intact(2) simple fracture of fibula(3) multifragmentary fracture of fibula(4) bifocal fracture of fibula1. With 3 intermediate fragments(43-A3.1)

2. More than 3 intermediate frag-ments (43-A3.2)

3. Extending into diaphysis (43-A3.3)

A1

A2

A3



Tibia/fibula, distal, partial articular, pure split (43-B1)(1) fibula intact(2) simple fracture of fibula(3) multifragmentary fracture of fibula(4) bifocal fracture of fibula1. Frontal (43-B1.1)(5) anterior(6) posterior (Volkmann)

2. Sagittal (43-B1.2)(5) lateral(6) medial (medial malleolus)

3. Metaphyseal multifragmentary(43-B1.3)

Tibia/fibula, distal, partial articular, split depression (43-B2)(1) fibula intact(2) simple fracture of fibula(3) multifragmentary fracture of fibula(4) bifocal fracture of fibula1. Frontal (43-B2.1)(5) anterior(6) posterior

2. Sagittal (43-B2.2)(5) lateral(6) medial

3. Of the central fragment (43-B2.3)

Tibia/fibula, distal, partial articular, depression (43-B3)(1) fibula intact(2) simple fracture of fibula(3) multifragmentary fracture of fibula(4) bifocal fracture of fibula1. Frontal (43-B3.1)(5) anterior(6) posterior

2. Sagittal (43-B3.2)(5) lateral(6) medial

3. Metaphyseal, multifragmentary(43-B3.3)

B1

B2

B3



Tibia/fibula, distal, complete articular, articular multifragmentary (43-C3)(1) fibula intact(2) simple fracture of fibula(3) multifragmentary fracture of fibula(4) bifocal fracture of fibula1. Epiphyseal (43-C3.1) 2. Epiphysio-metaphyseal (43-C3.2) 3. Epiphysio-metaphysio-diaphyseal

(43-C3.3)

Tibia/fibula, distal, complete articular, articular simple, metaphyseal simple (43-C1)(1) fibula intact(2) simple fracture of fibula(3) multifragmentary fracture of fibula(4) bifocal fracture of fibula1. Without impaction (43-C1.1)(5) frontal plane(6) sagittal plane

2. With epiphyseal depression(43-C1.2)


Tibia/fibula, distal, complete articular, articular simple, multifragmentary metaphysis (43-C2)(1) fibula intact(2) simple fracture of fibula(3) multifragmentary fracture of fibula(4) bifocal fracture of fibula1. With asymmetric impaction(43-C2.1)(5) frontal plane split(6) sagittal plane split

2. Without asymmetric impaction(43-C2.2)


C1

C2

C3



BONE: TIBIA/FIBULA (4) Location: Malleolar segment (44)

Types:A. Infrasyndesmotic lesion (44-A)

Groups:Tibia/fibula, malleolar, infrasyndesmotic lesions (44-A)1. Isolated(44-A1)

2. With me-dial malleolarfracture(44-A2)

3. With postero-medialfracture(44-A3)

B. Transsyndesmotic fibula fracture (44-B) C. Suprasyndesmotic lesion (44-C)

2. With me-dial lesion(44-B2)

2. Multifrag-mentary frac-ture of fibulardiaphysis(44-C2)

Tibia/fibula, malleolar, transsyndesmotic fibula frac-ture (44-B)1. Isolated(44-B1)

Tibia/fibula, malleolar, suprasyndesmotic (44-C)

1. Simple dia-physeal fibular fracture (44-C1)

3. With me-dial lesionandVolkmann(fracture ofthe postero-lateral rim)(44-B3)

3. Proximalfibula (44-C3)



Subgroups and Qualifications:Tibia/fibula, malleolar, infrasyndesmotic, isolated (44-A1)1. Rupture of lateral collateral ligament (44-A1.1)

2. Avulsion of tip of lateral malleolus(44-A1.2)

3. Transverse fracture of lateral malle-olus (44-A1.3)

Tibia/fibula, malleolar, infrasyndesmotic lesion with medial malleolar fracture (44-A2)(1) transverse(2) oblique(3) vertical1. Rupture of lateral collateral ligament (44-A2.1)



Tibia/fibula, malleolar, infrasyndesmotic lesion with postero-medial fracture (44-A3)1. Rupture of lateral collateral ligament (44-A3.1)



A1

A2

A3



Tibia/fibula, malleolar, transsyndesmotic, isolated (44-B1)1. Simple (44-B1.1) 2. Simple with rupture of anterior

syndesmosis (44-B1.2)(1) in substance(2) Chaput (anterior tibia)(3) Lefort (anterior fibula)

3. Multifragmentary (44-B1.3)

Tibia/fibula, malleolar, transsyndesmotic fracture with medial lesion (44-B2)1. Simple, rupture of medial collateral and anterior syndesmosis (44-B2.1)(1) in substance(2) Chaput(3) Lefort

2. Simple with fracture of medialmalleolus and rupture of anterior syn-desmosis (44-B2.2)(1) in substance(2) Chaput(3) Lefort

3. Multifragmentary (44-B2.3)(1) rupture of medial collateral ligament(2) fracture of medial malleolus

Tibia/fibula, malleolar, transsyndesmotic with medial lesion and a Volkmann (fracture of posterolateral rim) (44-B3)(1) extra-articular avulsion(2) peripheral articular fragment(3) significant articular fracture1. Fibula simple with medial collateral ligament rupture (44-B3.1)

2. Simple fibula fracture with fractureof medial malleolus (44-B3.2)

3. Multifragmentary with fracture ofmedial malleolus (44-B3.3)

B1

B2

B3



Tibia/fibula, malleolar, suprasyndesmotic, proximal fibular lesion (44-C3)(1) fracture through neck(2) fracture through head(3) proximal tibiofibular dislocation(4) rupture of medial collateral ligament(5) fracture of medial malleolus(6) articular fragment1. Without shortening, without Volkmann (44-C3.1)

2. With shortening, withoutVolkmann (44-C3.2)

3. Medial lesion and a Volkmann(44-C3.3)

Tibia/fibula, malleolar, suprasyndesmotic, multifragmentary fibular diaphyseal fracture (44-C2)1. With rupture of medial collateral ligament (44-C2.1)

2. With fracture of medial malleolus(44-C2.2)

3. With fracture of medial malleolusand a Volkmann (Dupuytren)(44-C2.3)(1) extra-articular avulsion(2) peripheral articular fragment(3) significant articular fragment

Tibia/fibula, malleolar, susprasyndesmotic, simple diaphyseal fracture of fibula (44-C1)1. Rupture of medial collateral ligament (44-C1.1)

2. With fracture of medial malleolus(44-C1.2)

3. With fracture of medial malleolusand a Volkmann (Dupuytren)(44-C1.3)(1) extra-articular avulsion(2) peripheral articular fragment(3) significant articular fragment

C1

C2

C3


PELVIS


The classification of pelvic ring and acetabular fractures isbased on the work of Pennal and Tile and Judet and Letournel.This classification was developed to accommodate the alpha-numeric system of The Comprehensive Long Bone System.

DEFINITIONS

Pelvic ring has two arches: (a) posterior arch is behind ac-etabular surface and includes sacrum, sacroiliac joints andtheir ligaments and posterior ilium, and (b) anterior arch is infront of acetabular surface and includes pubic rami bone andsymphyseal joint.

Anterior column of acetabulum extends from the anterior halfof the iliac crest to the pubis (iliopubic).

Posterior column of acetabulum extends from the greater

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Clasificacion OTA Completa